Exacerbation and mortality in COPD patients on triple inhaler and at high exacerbation risk

<bold>Objective:</bold> To describe exacerbations and death rates in a cohort of COPD patients at high risk of exacerbation whilst on maximal inhaled maintenance therapy. <bold>Methods:</bold> A retrospective cohort study of people aged ≥40 years with COPD diagnosis used the US Optum’s de-identified Market Clarity Data (2015-2019). Index date (ID) was when the following criteria were met: continuous 12-month baseline period of treatment with dual or triple therapy (TT); evidence of either ≥2 moderate or ≥1 severe exacerbation during baseline. Follow up was from ID to death, out of database, or end of 2019. Baseline characteristics and incidence rates (IR) per 100 person-years (PY) of exacerbation and death were described in all and TT patients. <bold>Results:</bold> Characteristics of overall (n=16,968) and TT cohorts (n=4,920; 29%) were similar (Table). During a mean follow-up of 21 (SD=12) months, 3,534 (72%) of TT patients had ≥1 subsequent exacerbation (IR 108.2 per 100PY, 95%CI 104.7-111.8). Death occurred in 685 (14%) TT patients (IR 8.0 per 100PY, 95%CI 7.4-8.6). Overall cohort showed similar findings. <bold>Conclusions:</bold> In this cohort, those people with a history of exacerbations whilst on maximal inhaled maintenance therapy – one sixth also using add-on therapy – experienced poor outcomes over time. Optimization of COPD management and new therapies are needed to reduce disease burden in severe exacerbating patients. <fig><object-id>erj;64/suppl_68/PA1287/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>